Malignant Pleural Mesothelioma Presenting Research Articles

S2077 Metastatic Malignant Pleural Mesothelioma Presenting as Sigmoid Polyps

S2077 Metastatic Malignant Pleural Mesothelioma Presenting as Sigmoid Polyps

Malignant Sarcomatoid Pleural Mesothelioma Presenting as a Chest Wall Tumor

Malignant Sarcomatoid Pleural Mesothelioma Presenting as a Chest Wall Tumor

P2.06-33 Heterogeneity in Care Pathways for Patients with Malignant Pleural Mesothelioma Presenting at a Quaternary Thoracic Oncology Center in Quebec

Malignant pleural mesothelioma (MPM) is a rare disease for which diagnostic and therapeutic trajectories are ill-defined. We hypothesize that MPM patients experience delays during their diagnostic and therapeutic trajectory with significant heterogeneity in care pathways. Thus, we evaluated management practices at the MUHC over the past 10 years to address the need for a centralized program and dedicated care team. We conducted a retrospective chart review of MPM cases diagnosed at our center from 2006 to 2016. Clinical, pathologic, and treatment variables were collected. We assessed time from first abnormal imaging to definitive diagnosis, time from definitive diagnosis to first treatment and time from definitive diagnosis to palliative care consult. Overall survival was analyzed by Kaplan Meir method. We identified 145 patients over a 10-year period and report outcomes on 92 cases with complete data. Demographic data are presented in Table 1. Overall survival was 1.4% at 5-years for all patients, with a median survival of 1 year following a definitive diagnosis. Forty-five percent of patients underwent an investigational PET/CT scan, 89% of patients had M0 status prior to treatment, of whom 20% developed extra-thoracic metastases. Sixty-three percent of patients received some form of treatment. Eight treatment combinations were identified, irrespective of intent, lymph node involvement, and metastatic status. With regards to delays in care pathway, median time from first abnormal imaging to definitive diagnosis was 34 days (IQR 20.5 to 55), definitive diagnosis to first therapeutic intervention was65 days (IQR 35.8 to 163.8), and definitive diagnosis to palliative consult was 289 days (IQR 3 to 1651).Table 1Demographics and treatment characteristics of patients diagnosed with MPM at the McGill University Health Center over a 10-year period.CharacteristicsOverallSample size92AgeNumber (%)Median (IQR)72 (62-79.5)Female Gender, n (%)19 (20.7)Previous or current smoker, n (%)36 (39.1)Asbestos ExposureNo20 (21.7)Yes36 (39.1)Unknown36 (39.1)Type of MPMBiphasic9 (9.8)Desmoplastic3 (3.3)Epitheliod67 (72.8)Sarcomatoid3 (3.3)Not otherwise specified10 (10.9)TreatmentNo28 (30.4)Yes58 (63.0)Unknown6 (6.5)Treatment CourseChemotherapy only8 (13.8)Chemo and Radiotherapy5 (8.6)Radiotherapy only15 (25.9)Surgery only10 (17.2)Trimodality therapy7 (12.1)Surgery and Chemo7 (12.1)Surgery and Radiotherapy4 (6.9)Concurrent therapy2 (3.4)Intent at first treatmentCurative31 (53.4)Palliative24 (41.4)Unknown3 (5.2) Open table in a new tab

Malignant Pleural Mesothelioma presenting with Cardiac Tamponade- A Rare Case report and Review of the literature.

Mesothelioma is a rare tumor of the pleura, peritoneum, pericardium or tunica vaginalis. About 2,500 cases are diagnosed annually in the United States. Mesothelioma often presents with pleuritic chest pain and dyspnea related to local invasion; distal metastasis and lymphadenopathy at the time of diagnosis is rare. Pericardial involvement in mesothelioma is related to direct invasion of the tumor. We here present a 71 year-old-male who presented with pleuritic chest pain and dyspnea, noted to have diffuse ST-segment elevation in EKG and cardiac tamponade physiology on 2D echocardiogram in who imaging subsequently revealed left upper lung mesothelioma. A pericardial window was created following which tamponade resolved. The pericardial biopsy did not show any mesothelioma cells or fibrous plaques. Computer tomography revealed regional lymphadenopathy in the chest. Disrupted cardiac lymphatic flow due to tumor mesothelioma induced lymphadenopathy is likely cause of the cardiac tamponade in this patient. This is the second ever reported case of pleural mesothelioma without a direct pericardial invasion that presented with cardiac tamponade.

A unique case of malignant pleural mesothelioma presenting with highly aggressive multiple brain metastases after a long disease-free period

Malign plevral mezotelyoma (MPM) nadir gorulen plevra ya da peritondaki mezotelyal hucrelerden koken alan, kotu prognozlu, nadir ve agresif bir malign neoplazidir. Mezotelyomanin sadece lokal direkt invazyon yolu ile lokal olarak metastaz yaptigi; uzak yayilim yapmadigi dusunulmektedir. Uzak metastazlar post mortem incelemeler sonucu ortaya cikmaya baslamistir. Son zamanlarda yapilan post mortem calismalarda %3 vakada santral sinir sistemi metastazlari bildirilmistir. 55 yasinda hasta ilk tanisindan 4 yil sonra coklu agresif beyin metastazlari ile basvurdu. Rezeksiyona uygun olmayan lezyonlar nedeniyle palyatif kraniyal radyoterapi verildi. Radyoterapinin tamamlanmasindan 3 ay sonra hasta kaybedildi. Bu hastalikta uzak metastaz paterni ongorulebilir olmadigi icin, sistemik relapslari onlemede ilk tani esnasinda yuksek risk faktorlerine dikkat edilmelidir. Multimodal tedaviler bu hastalikta daha uzun sagkalim saglayabilmektedir. Klinisyenler MPM’de ozellikle erken yas, ileri evre ve epiteloid disi ozellikleri bulunan hastalarda beyin metastazi icin dikkatli tarama yapmalidirlar.

両側気胸を契機に発見された悪性胸膜中皮腫の1例

両側気胸を契機に発見された悪性胸膜中皮腫の1例

Left-sided malignant pleural mesothelioma presenting with recurrent pneumothorax 7 years after the right pleuropneumonectomy

Malignant pleural mesothelioma (MPM) is an extremely aggressive tumor arising from the pleura with a median survival of approximately 9–12 months. It can rarely present as a spontaneous pneumothorax. We herein reported a 65-year-old female patient with the left-sided MPM presenting with episodes of recurrent spontaneous pneumothorax. She had undergone the right pleuropneumonectomy due to the right-side MPM 7 years ago. She admitted to our clinic with diagnosis of left pleural effusion. The patient underwent pleural biopsy and talc pleurodesis by thoracoscopy. Histologic study showed the epithelial subtype of MPM. She received chemotherapy nine times. Seven years after the right pleuropneumonectomy, she had recurrent left-sided spontaneous pneumothorax four times that was treated one by one with tube thoracostomy. We did not perform surgical treatment because of the unsuitable status of the patient. It should be kept in mind that, when pneumothorax develops in the remaining lung after a single-sided pneumonectomy, this may be due to the tumor.

Extended Survival After Accidental Finding of Malignant Pleural Mesothelioma Presenting as Solitary Lung Nodule

Extended Survival After Accidental Finding of Malignant Pleural Mesothelioma Presenting as Solitary Lung Nodule

Malignant pleural mesothelioma presenting as a spontaneous pneumothorax

Malignant pleural mesothelioma (MPM) is thought to arise from the mesothelial cells that line the pleural cavities. Most patients initially experience the insidious onset of chest pain or shortness of breath and have a history of asbestos exposure. MPM rarely presents as spontaneous pneumothorax. We report two male patients who presented with a spontaneous hydropneumothorax. One was exposed to asbestos and the other was not. Computed tomography showed tiny nodules with pleural thickness. They both underwent pleural effusion cytology and/or pleural biopsy. Therefore, the pathological diagnosis of MPM was obtained in both cases. We also reviewed 16 Japanese MPM cases with pneumothorax including our two patients. More than half of the patients suffered from pneumothorax repeatedly. We emphasize the need to obtain a pathological diagnosis of pleural effusion cytology and/or pleural biopsy in older patients presenting with a spontaneous hydropneumothorax.

Frequency of surgery in black patients with malignant pleural mesothelioma.

e17571 Background: We evaluated the role of race in presentation, treatment, and survival of malignant pleural mesothelioma (MPM) in the Survival Epidemiology and End Results (SEER) database. Metho...

血胸を契機に診断した淡明細胞型の悪性胸膜中皮腫の一例

症例は76歳，男性で，肝硬変・肝細胞癌等で当院消化器外科に通院中で，息苦しさを自覚し左胸水の増加を認めた．胸水中のヘマトクリットは29.4%と血性胸水であった．CTにて胸壁に造影効果を伴う胸膜肥厚や結節影を認め，胸腔ドレーンより約2時間で約2000 ml以上の血性の排液があり，止血と生検目的にて緊急手術となった．術中所見は胸壁全体から出血がみられ，胸壁と肺実質に浸潤する腫瘍と，びまん性に播種巣を認めた．腫瘍は非常にもろく，易出血性であった．病理診断にて充実性に増殖する淡明な胞体をもつ上皮様の異型細胞を認め，免疫組織化学により淡明細胞型の悪性胸膜中皮腫と診断した．カルボプラチンとペメトレキセートにて化学療法を2コース施行したが，進行し111日目に永眠された．今回血胸を契機に診断した淡明細胞型の悪性胸膜中皮腫を経験したので若干の文献的考察を加え報告する．

Malignant Pleural Mesothelioma Presenting as Acute Empyema with Severe Leukocytosis

Five months after the treatment for acute empyema, a 75-year-old woman was referred to our hospital because of marked elevation of the white blood cell (WBC) count and C-reactive protein (CRP) level, and a right pleural mass detected by chest computed tomography. At this time, the WBC count and CRP level had increased to 60400/microl and 18.2 mg/dl, respectively. We performed biopsy and the tumor was diagnosed as sarcomatoid malignant pleural mesothelioma. Malignant pleural mesothelioma occasionally presents the symptoms and findings like an acute empyema. We demonstrated the case of malignant pleural mesothelioma which had presented the symptoms and laboratory findings very similar to acute empyema and had treated as acute empyema.

Malignant Pleural Mesothelioma Presenting with Spontaneous Hydropneumothorax

Malignant Pleural Mesothelioma Presenting with Spontaneous Hydropneumothorax

Analysis of “dry” mesothelioma with ultrasound guided biopsies

BackgroundImage-guided sampling of the thickened pleura is a sensitive approach in patients with malignant pleural mesothelioma with pleural effusion. Malignant pleural mesothelioma presenting without effusion however is more of a diagnostic challenge. In this study we report the diagnostic yield and complications of ultrasound-guided cutting needle biopsies in this particular category of patients. MethodsA retrospective database analysis from September 2007 until January 2012 was performed in 56 patients with malignant pleural mesothelioma. Clinical characteristics and results of diagnostic evaluations were analysed. ResultsOf the 56 patients with malignant pleural mesothelioma, 20 patients presented without pleural effusion of with locular effusion. Ultrasound-guided cutting needle biopsy was performed in 14/20 patients with a diagnostic accuracy of 80%. Only 1 patient had mild haemoptysis immediately following biopsies. ConclusionDiagnosing patients with pleural thickenings suspect for malignant mesothelioma without pleural effusion or with loculated pleural effusion is effective and safe with ultrasound-guided cutting needle biopsies.

Paraneoplastic leukocytoclastic vasculitis as an initial presentation of malignant pleural mesothelioma: a case report

IntroductionVasculitis has been associated with malignancies, more commonly hematological rather than solid malignancies. Due to the rarity of these conditions and the lack of a temporal association, the relationship between vasculitis and malignancy remains unclear. Paraneoplastic vasculitis as a phenomenon of lung cancer has been described in the literature. To the best of our knowledge, this is the first case report of leukocytoclastic vasculitis being an initial presentation of malignant pleural mesothelioma.Case presentationWe report the case of an 84-year old Greek man who presented to our facility with an erythematous, pruritic and purpuric rash affecting his limbs. This was biopsy-proven to be leukocytoclastic vasculitis and treated conservatively with topical corticosteroids as well as oral prednisolone, with good results. Six months later, he was diagnosed as having malignant pleural mesothelioma. As he remained asymptomatic from his malignancy, no systemic chemotherapy was instituted. He had a recurrence of biopsy-proven leukocytoclastic vasculitis two months after he was diagnosed as having mesothelioma, which again settled with conservative measures.ConclusionsIt is important to remain vigilant with regard to the association between leukocytoclastic vasculitis and malignancies. A diagnosis of vasculitis requires a search for malignancies as well as other possible etiologies. This is particularly of relevance when the vasculitis becomes chronic, recurrent or treatment is no longer effective. Should our patient have experienced refractory vasculitis, we would have instituted systemic chemotherapy to treat the underlying malignancy.

Spinal cord compression: an unusual presentation of malignant pleural mesothelioma. A case report and review of the literature.

Pleural malignant mesothelioma is a locally invasive tumor that tends to progress due to direct extension of the tumor into the pulmonary parenchyma, the chest wall, the mediastinum, or the abdominal cavity via the diaphragm. In the later stages of the disease, distant metastases can occur. Metastases to the nervous system are rare, and clinical signs of nervous system involvement typically appear between 2 months and 6 years after the primary diagnosis. However, the case presented here manifested as neurological impairment without any respiratory symptoms.

Malignant pleural mesothelioma presenting with a spontaneous hydropneumothorax: A report of 2 cases

Malignant pleural mesothelioma (MPM) originates in the mesothelial cells that line the pleural cavities. Most patients initially experience the insidious onset of chest pain or shortness of breath and have a history of asbestos exposure. It rarely presents as spontaneous pneumothorax. We report here two cases where malignant pleural mesothelioma presented with a spontaneous hydropneumothorax and was only discovered following surgery. We emphasise the need for a chest CT-scan preoperatively in older patients presenting with a secondary pneumo/hydropneumothorax.

Malignant pleural mesothelioma presenting with a spontaneous hydropneumothorax: A report of 2 cases

Malignant pleural mesothelioma (MPM) originates in the mesothelial cells that line the pleural cavities. Most patients initially experience the insidious onset of chest pain or shortness of breath and have a history of asbestos exposure. It rarely presents as spontaneous pneumothorax. We report here two cases where malignant pleural mesothelioma presented with a spontaneous hydropneumothorax and was only discovered following surgery. We emphasise the need for a chest CT-scan preoperatively in older patients presenting with a secondary pneumo/hydropneumothorax.

A Rare Cause of Dysphagia: Malignant Pleural Mesothelioma in the Posterior Mediastinum

A 69-year-old man presented to the emergency room with dysphagia and vomiting. A computed tomographic scan revealed a posterior mediastinal mass surrounding the lower portion of the esophagus. Endoscopic examination demonstrated narrowing of the lower esophagus without malignant mucosal lesions. Thoracoscopic biopsies of the mediastinal mass failed to yield a pathologic diagnosis. The hyaluronic acid concentration in the left pleural effusion was remarkably high (755 mg/L), which is a finding strongly suggestive of malignant mesothelioma. Four months after the initial admission, a subcutaneous nodule was found in the left chest wall and a biopsy was taken. The histopathologic and immunohistochemical findings of the biopsy were consistent with the diagnosis of pleural malignant mesothelioma.

Brain Metastasis in Malignant Pleural Mesothelioma Presenting as Intratumoral Hemorrhage -Case Report-

A 51-year-old man presented with a rare case of brain metastasis of malignant pleural mesothelioma (MPM) manifesting as intratumoral hemorrhage. He had undergone several treatments such as left pneumonectomy, pleurectomy, chemotherapy with cis-diamminedichloroplatinum and gemcitabine hydrochloride, and irradiation. Five years later, computed tomography revealed right parietal metastasis with intratumoral hemorrhage and the patient was treated by surgery and irradiation. Six months after the surgery, recurrent intratumoral hemorrhage occurred and a second surgery was performed. MPM has a poor prognosis and brain metastasis is rare, but long-term survival has recently improved through the application of multi-modality approaches. Therefore, the number of opportunities for treating MPM metastasis will increase in the near future. Intratumoral hemorrhage may occur in patients with solitary brain metastasis of MPM, so surgery should be considered as a general candidate treatment for metastatic tumors.